Li Xuemei, Liu Chang, Chen Hongxiu, Wu Zhoupeng, Liang Danmei, Zhang Xiaoxia
West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, P.R. China/Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China.
Disaster Medical Center, Sichuan University, Chengdu, Sichuan Province, P.R. China.
Medicine (Baltimore). 2025 Jun 20;104(25):e42800. doi: 10.1097/MD.0000000000042800.
Correct catheter tip placement is the foundation for catheter utilization and the prevention of catheter-related complications. We describe 2 unusual peripherally inserted central catheter (PICC) malpositions in the left thymic vein and the right middle thyroid vein, which are, to our knowledge, the first 2 cases of PICC malposition in these 2 veins.
Both patients had subtle clinical signs of catheter malposition on initial post-procedure chest X-ray radiography or during catheter duration. However, all signs were overlooked.
Two catheter malpositions were incidentally discerned and diagnosed using a winding and delayed modality.
One of the catheters was removed at a local hospital, the other catheter tip was adjusted to the superior vena cava by the advanced practice nurse.
Two catheter malpositions were incidentally discerned and diagnosed over the course of a winding and delayed procedure, resulting in belated catheter manipulation.
Although neither patient experienced significant catheter tip-related events, the delayed diagnostic process led to the presentation of these 2 unusual cases, to guide further recognition of this complication. Some principles should be followed to avoid rare PICC malposition and its fatal complications, including verification of tip before using catheter, use of real-time imaging guidance, regular monitoring of long-term dwelling catheter, and proactive assessment of catheter or direct communication with radiologists particularly in cases where catheter tip malposition is highly suspected.
正确的导管尖端位置是导管使用及预防导管相关并发症的基础。我们描述了2例外周静脉穿刺中心静脉导管（PICC）异常位置，分别位于左胸腺静脉和右甲状腺中静脉，据我们所知，这是首例报道的PICC在这两条静脉中的异常位置。
两名患者在术后首次胸部X线摄影或置管期间均有导管位置异常的细微临床体征，但所有体征均被忽视。
通过迂回和延迟的方式偶然发现并诊断出两例导管位置异常。
其中一根导管在当地医院被拔除，另一根导管的尖端由高级执业护士调整至上腔静脉。
在迂回和延迟的过程中偶然发现并诊断出两例导管位置异常，导致导管操作延迟。
尽管两名患者均未发生与导管尖端相关的重大事件，但诊断过程的延迟导致了这两例罕见病例的出现，以指导对该并发症的进一步认识。应遵循一些原则以避免罕见的PICC位置异常及其致命并发症，包括在使用导管前确认尖端位置、使用实时成像引导、定期监测长期留置导管，以及在高度怀疑导管尖端位置异常的情况下主动评估导管或与放射科医生直接沟通。
